Diabetes in pregnancy: are we providing the best care ... - HQIP

Neonatal care of term babies
12.8.1 Enquiry fi ndings
There was evidence of a clear written care plan for 73% (51/70) of babies who remained with their mothers
and 57% (24/42) of babies admitted to a neonatal unit (table 12.12). The plan referred to a hospital
protocol in a third or less of the cases, and included advice about blood glucose monitoring and feeding
more consistently than for other areas of care. A temperature management plan was present in less than
half of babies, and the recommended location of care was documented for a third of babies remaining
with their mothers and two thirds of babies admitted to a neonatal unit. The care plan was written by the
paediatric Senior House Offi cer for 57% (42/74) of babies and by the midwife for 15% (11/74) of babies. In
22% of cases, there was insuffi cient information in the notes to determine who had written the care plan.
The care plan was not fully followed for 35% (18/51) of babies remaining with their mother; aspects of the
care plan not followed included blood glucose management, feeding and temperature control.
Table 12.12
Written care plan for babies of women with type 1 and type 2 diabetes
Babies remaining with mother
n(%)*
(N=70)
Babies admitted to NNU
n(%)*
(N=42)
p-value
Evidence of a written plan 51 (73) 24 (57) 0.12
Plan refers to hospital protocol 17 (33) 5 (21) 0.27
Location of care 18 (35) 16 (67) 0.01
Blood glucose monitoring 47 (92) 19 (79) 0.16
Temperature management 24 (47) 7 (29) 0.14
Feeding 43 (84) 16 (67) 0.12
* Percentages are calculated for each aspect of the care plan after excluding missing data.
12.9 Conclusions
The overall fi ndings of this enquiry into the neonatal care of term babies born to mothers with diabetes
suggested that:
• There were many concerns about clinical care and documentation, especially on the labour ward:
• Avoidable admissions had an adverse effect on the establishment of breastfeeding
• Initial support for early mother-baby contact and breastfeeding was inconsistent
• Timing and method of blood glucose monitoring was inconsistent.
• There was little evidence of senior paediatric staff involvement in the management of this group of
babies.
• Many healthy babies of mothers with diabetes were separated from their parents without a good
medical reason. The design of most maternity units, where neonatal expertise is predominantly
concentrated in the neonatal unit, may partly explain why trusts are reluctant to provide care for
these higher risk babies on a postnatal ward with their mothers. Bringing neonatal expertise close to
the mothers as occurs in transitional care wards, may be the solution.
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